Sepsis

Summary of Evidence for Initiation of Vasopressors using PIV

Overall, the evidence supports the use of peripheral access for initiation of vasopressors in pediatric shock.  The American College of Critical Care Medicine Clinical Practice Parameters (2017) recommend earlier use of inotrope support through peripheral access until central access is attained.1  Though limited by a lack of large, multicenter studies, the literature thus far has shown that initiation of peripheral vasopressors is safe in pediatrics.2,3,4,5  The dose and duration of infusion are predictors of complications in the adult literature.6,7

Based on the review of the evidence, the MRC supports the use of peripheral intravenous access for the initiation of vaopressors in pediatric shock.

  1. Davis, A. L., Carcillo, J. A., Aneja, R. K., Deymann, A. J., Lin, J. C., Nguyen, T. C., … & Zuckerberg, A. L. (2017). American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Critical care medicine, 45(6), 1061-1093.
  2. Chidambaram, M., & Rameshkumar, R. (2021). Infusion of vasoactive drug through peripheral line: A myth or fact?. Journal of Pediatric Critical Care, 8(2), 63.
  3. Charbel, R. C., Ollier, V., Julliand, S., Jourdain, G., Lode, N., Tissieres, P., & Morin, L. (2021). Safety of early norepinephrine infusion through peripheral vascular access during transport of critically ill children. Journal of the American College of Emergency Physicians Open, 2(2), e12395.
  4. Patregnani, J. T., Sochet, A. A., & Klugman, D. (2017). Short-term peripheral vasoactive infusions in pediatrics: where is the harm?. Pediatric Critical Care Medicine, 18(8), e378-e381.
  5. Turner, D. A., & Kleinman, M. E. (2010). The use of vasoactive agents via peripheral intravenous access during transport of critically III infants and children. Pediatric emergency care, 26(8), 563-566.
  6. Lewis, T., Merchan, C., Altshuler, D., & Papadopoulos, J. (2019). Safety of the peripheral administration of vasopressor agents. Journal of intensive care medicine, 34(1), 26-33.
  7. Loubani, O. M., & Green, R. S. (2015). A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. Journal of critical care, 30(3), 653-e9.